Long-term economic effects of team-based clinical case management of patients with chronic minor disease and long-term absence from working life.
OBJECTIVE
To examine the socio-economic effects of team-based clinical case management of patients with chronic minor disease bound for early retirement.


METHODS
Marginal analysis of programme costs and benefits to society compared with no-programme baseline of costs occurring in society due to productivity loss. Prospective patient data collection on admission, discharge, and at one year and five years after discharge to determine programme effectiveness.


METHODS
Out-patient clinic at the department of social medicine in tertiary care hospital.


METHODS
239 patients with minor disease and long-term vocational absence consecutively admitted to the study. At the one-year evaluation, 17 patients had been readmitted to the team, 7 could not be found, 6 declined the interview and 2 were deceased. At the five-year evaluation of 49 patients who were active after one year, one was deceased and 10 were unable to be found.


METHODS
Vocational activity. Programme costs. Benefits to society measured by decrease in indirect costs.


RESULTS
The one-year vocational rehabilitation rate from the program was 20.5% and the five-year rehabilitation rate was 11.3%. The total discounted cost for case management of the 239 patients was 7.3 MSEK (600,000 Pounds). The decrease in the indirect costs to society from the 28 patients found active after five years was 35.1 MSEK (2,500,000 Pounds). The net present value of the programme at the 1991 price level was 27.5 MSEK (2,365,000 Pounds).


CONCLUSIONS
Tertiary care level team-based clinical case management for vocational rehabilitation of patients with chronic minor disease has a positive cost-benefit ratio. A cross-boundary awareness at a health policy level is needed of the societal costs involved for this group of patients who fall between the traditional services in health care and social work.
Timpka
T
T
Department of Social Medicine, Linköping University Hospital, Sweden. tooti@ida.liu.se
Leijon
M
M
Karlsson
G
G
Svensson
L
L
Bjurulf
P
P
D000041:Absenteeism; D000328:Adult; D019090:Case Management / Q000191:economics*; D002908:Chronic Disease / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D010348:Patient Care Team; D012050:Rehabilitation, Vocational / Q000191:economics*; D013548:Sweden; D013997:Time Factors